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1760668222 NPI number — CHRISTIE M WILSON SLP

NPI Number: 1760668222
Health Care Provider/Practitioner: CHRISTIE M WILSON SLP

Information about “1760668222” NPI (CHRISTIE M WILSON SLP) exists in 1760668222 in HTML format HTML  |  1760668222 in plain Text format TXT  |  1760668222 in PDF (Portable Document Format) PDF  |  1760668222 in an XML format XML  formats.

NPI Number : 1760668222 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760668222",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "CHRISTIE",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SMITH",
    "OtherFirstName": "CHRISTIE",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2811 LONGVIEW DR",
    "SecondLineMailingAddress": "SUITE C",
    "MailingAddressCityName": "JONESBORO",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72401-5919",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "870-974-9114",
    "MailingAddressFaxNumber": "870-974-9184",
    "FirstLinePracticeLocationAddress": "1801 GRANT AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JONESBORO",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72401-6155",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "870-974-9114",
    "PracticeLocationAddressFaxNumber": "870-974-9184",
    "EnumerationDate": "01/15/2008",
    "LastUpdateDate": "01/28/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "SP2523",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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